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813-780-0020 City of Zephyrhills Fire. Fax - 813780 -0021 <br /> Permit Application <br /> Date Received �Jr 2.,,.../...10 Phone Contact for Permit • /3 t 7S <br /> Owner's Name 2. l Qh r hC.....ef . Owners Phone Number <br /> 1l I <br /> Owners Address <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> 1 11 I <br /> Fee Simple Titleholder Address I <br /> . S, .�L., �:' - •v4%w.sru'.,, f,_ _ <br /> Job Address 3 p O' L ( I <br /> SO �� 3 3 S / / Lot # <br /> Sub Division Parcel # <br /> ,.._. _ -, - - :,. .::,,ii r- �%% .., x.'. :' ° -L .. 'r+ :: ✓,. ..j.r✓E .w'.a... ✓E'h x's Vii.. +(,2_ L-- .`v. ,rc, <br /> n Bio -Hazard Waste Storage - ANNUAL I I Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> F Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> lUtriy! !Semi) Uther <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I <br /> I I I prinkler System Installations <br /> Hood Suppression T 1 ❑ 1/ ❑ I Standpipes (Sprinkler Sys) <br /> El Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> Flammable Application- ANNUAL <br /> 1 ( Valuation of Project <br /> a Fuel Tanks <br /> n Other: I <br /> Contractor <br /> � Company Knit-/C - poa - p,r ., note...* <br /> I <br /> Signature Registered Y / N Fee Current <br /> I Y / N <br /> Address I L j 7 Q 1 G A 1 - 7 .1 r i Lam+ - 1 _ '( I License # r 4/ 1 coo l <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N j Fee Current I Y/ N I <br /> Address I <br /> 1 License # I <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # <br /> MECHANICAL Company 1 <br /> Signature Registered Y / N 1 Fee Current I Y / N I _ <br /> Address I <br /> 1 License # I I <br /> iw <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address <br /> License # <br /> Directions: <br /> Fill out application completely. <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) <br /> If over $2500, a Notice of Commencement is required (Mechanical work over $5000) <br /> Supply two (2) sets of drawings with applicable documentation <br /> Allow 10 -14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (httpi /appraiser.pascogov.com) <br />